B104 (FORM 104) (08/07)

ADVERSARY PROCEEDING COVER SHEET ADVERSARY PROCEEDING NUMBER

(Court Use Only)
(Instructions on Reverse)

PLAINTIFFS DEFENDANTS

ATTORNEYS (Firm Name, Address, and Telephone No.) ATTORNEYS (If Known)

PARTY (Check One Box Only) PARTY (Check One Box Only)
Debtor U.S. Trustee/Bankruptcy Admin Debtor U.S. Trustee/Bankruptcy Admin
Creditor Trustee Other Creditor Trustee Other

CAUSE OF ACTION (WRITE A BRIEF STATEMENT OF CAUSE OF ACTION, INCLUDING ALL U.S. STATUTES INVOLVED)

NATURE OF SUIT
(Number up to five (5) boxes starting with the lead cause of action as 1, first alternative cause as 2, second alternative cause as 3, etc.)

FRBP 7001(1) – Recovery of Money/Property FRBP 7001(6) – Dischargeability (continued)

11 - Recovery of money/property - § 542 turnover of property
12 - Recovery of money/property - § 547 preference
13 - Recovery of money/property - § 548 fraudulent transfer
14 - Recovery of money/property - other
(other than domestic support)
61 - Dischargeability - § 523(a)(5), domestic support
68 - Dischargeability - § 523(a)(6), willful and malicious injury
63 - Dischargeability - § 523(a)(8), student loan
64 - Dischargeability - § 523(a)(15), divorce or separation obligation

FRBP 7001(2) – Validity, Priority or Extent of Lien 65 - Dischargeability - other

21 - Validity, priority or extent of lien or other interest in property
FRBP 7001(7) – Injunctive Relief
FRBP 7001(3) – Approval of Sale of Property 71 - Injunctive relief - imposition of stay
31 - Approval of sale of property of estate and of a co-owner - § 363(h) 72 - Injunctive relief - other
FRBP 7001(4) – Objection/Revocation of Discharge FRBP 7001(8) – Subordination of Claim or Interest
41 - Objection/revocation of discharge - § 727(c), (d), (e) 81 - Subordination of claim or interest
FRBP 7001(5) – Revocation of Confirmation FRBP 7001(9) – Declaratory Judgment
51 - Revocation of confirmation 91 - Declaratory judgment
FRBP 7001(6) – Dischargeability FRBP 7001(10) – Determination of Removed Action
66 - Dischargeability - § 523(a)(1), (14), (14A) priority tax claims 01 - Determination of removed claim or cause
62 - Dischargeability - § 523(a)(2), false pretenses, false representation,
Other
actual fraud
SS-SIPA Case - 15 U.S.C. §§ 78aaa et. seq.
67 - Dischargeability - § 523(a)(4), fraud as fiduciary, embezzlement, larceny 02 - Other (e.g. other actions that would have been brought in state court if
(continued next column) unrelated to bankruptcy case)

Check if this case involves a substantive issue of state law Check if this is asserted to be a class action under FRCP 23

Check if a jury trial is demanded in complaint Demand $

Other Relief Sought

 B104 (FORM 104) (8/07), Page 2

BANKRUPTCY CASE IN WHICH THIS ADVERSARY PROCEEDING ARISES

NAME OF DEBTOR BANKRUPTCY CASE NO.

DISTRICT IN WHICH CASE IS PENDING DIVISION OFFICE NAME OF JUDGE

RELATED ADVERSARY PROCEEDING (IF ANY)

PLAINTIFF DEFENDANT ADVERSARY PROCEEDING NO.

DISTRICT IN WHICH ADVERSARY IS PENDING DIVISION OFFICE NAME OF JUDGE

SIGNATURE OF ATTORNEY (OR PLAINTIFF)

DATE PRINT NAME OF ATTORNEY (OR PLAINTIFF)

INSTRUCTIONS

The filing of a bankruptcy case creates an "estate" under the jurisdiction of the bankruptcy court which consists of all of
the property of the debtor, wherever that property is located. Because the bankruptcy estate is so extensive and the jurisdiction
of the court so broad, there may be lawsuits over the property or property rights of the estate. There also may be lawsuits
concerning the debtor’s discharge. If such a lawsuit is filed in a bankruptcy court, it is called an adversary proceeding.

A party filing an adversary proceeding must also must complete and file Form 104, the Adversary Proceeding Cover Sheet,
if it is required by the court. In some courts, the cover sheet is not required when the adversary proceeding is filed electronically
through the court's Case Management/Electronic Case Files (CM/ECF) system. (CM/ECF captures the information on Form 104
as part of the filing process.) When completed, the cover sheet summarizes basic information on the adversary proceeding. The
clerk of court needs the information to process the adversary proceeding and prepare required statistical reports on court activity.

The cover sheet and the information contained on it do not replace or supplement the filing and service of pleadings or
other papers as required by law, the Bankruptcy Rules, or the local rules of court. The cover sheet, which is largely self-
explanatory, must be completed by the plaintiff’s attorney (or by the plaintiff if the plaintiff is not represented by an attorney).
A separate cover sheet must be submitted to the clerk for each complaint filed.

Plaintiffs and Defendants. Give the names of the plaintiffs and defendants exactly as they appear on the complaint.

Attorneys. Give the names and addresses of the attorneys, if known.

Party. Check the most appropriate box in the first column for the plaintiffs and the second column for the defendants.

Demand. Enter the dollar amount being demanded in the complaint.

Signature. This cover sheet must be signed by the attorney of record in the box on the second page of the form. If the plaintiff
is represented by a law firm, a member of the firm must sign. If the plaintiff is pro se, that is, not represented by an attorney,
the plaintiff must sign.